Focal Therapy Will Be the Future Treatment Modality: The Motion “Con”

This is a special edition publication examining the merits and disadvantages of focal therapy to treat prostate cancer. Although several publications have already dealt with this topic, outlining the benefits of several novel techniques to treat prostate cancer, in this paper we focus on the argument from the “con” perspective and outline the rationale for why focal therapy as an approach to treat prostate cancer with current technologies is suboptimal. We provide the basis for this reasoning, discussing four focal treatment modalities; namely, high-intensity focused ultrasound, cryotherapy, radio frequency ablation, and photodynamic therapy. Given that none of the focal treatment options is without potential morbidity or mortality, that current technological limitations prevent complete mapping of the prostate and subsequent identification and treatment of all lesions, and that there is still significant potential for residual disease after focal treatment, we feel that a subset of men with favourable disease parameters who do not want definitive treatment may be better suited to undergo the less morbid treatment option, active surveillance.